Central lines for patients in the Intensive Care Unit (ICU)

Central lines are an essential aspect of the health care offered to patients in the Intensive Care Unit (ICU); they allow vascular access for fluid and total parenteral nutrition administration. Central lines predispose individuals to Central Line Associated Bacteremia, or CLABs, particularly when the health professional fails to take necessary safety precautions when providing drugs. CLABs result in longer durations of stay, higher health-care costs, and higher mortality rates. This study examines patients' susceptibility to CLABs when their health provider is a nurse practitioner or a member of a central line care team. The PICOT statement being; does the patient with the central line have less chances of obtaining CLABs when care is given by a central line care team who is responsible for central lines or by a nurse whose purpose is primary care and is new.

Abstract

Alexandrou, E. Murgo, M., Calabria, E. … & Hillman, K. M. (2011). Nurse-led central venous catheter insertion-Procedural characteristics and outcomes of three intensive care based catheter placement services. International Journal of Nursing Studies, 1-7.

This study was conducted to refute the claims of published data that nurse-led Central Venous Catheter, CVC, insertion had negative patient outcomes. Data collection involved the participation of three nurses who were trained in central line administration through their hospitals’ CLAB-ICU project initiative. This project acquainted the nurses in each facility with skills necessary for effective central line insertion with positive patient outcomes. Results showed that nurses can provide effective central line-related services if they have high procedural volume and skills on central venous catheterization.

O’Neil, Caroline., Ball, K. & Warren, D. (2016). A Central Line Care Maintenance Bundle for the Prevention of Catheter-Associated Bloodstream Infection in Non-ICU Settings. Infection Control and Hospital Epidemiology, 37(6): 692-698. doi: 10.1017/ice.2016.32

The study was conducted in a teaching hospital to determine the effectiveness of CVC care bundles among primary care givers. The care bundles involved consolidation of central line equipment and materials, nurses’ educational program, and follow ups. Results showed that the nurses under investigation had improved rates of CVC insertion and dressing but the CLABs rates remained high. The researchers concluded that there was a need to determine other strategies to reduce CLABs rates.

Perin, D. C., Erdmann, A. L. & Sasso, G. T. (2016). Evidence-based measures to prevent central line-associated bloodstream infections: a systematic review. Rev Lat Am Enfermagem, 24. doi: 10.1590/1518-8345.1233.2787

The objective of the study was to delineate evidence-based care of central line related cases among hospitalized adults in the ICU. Data was collected in medicine-related databases that highlighted care bundles and strategies used by health facilities to reduce CLABs rates. The researchers found out that CLABs rates reduced significantly in health institutions that had dedicated staff with high procedural volumes and skills in handling central lines.

Esposito,M. R., Guillari, A. & Angelillo, I. F. (2017). Knowledge, attitudes and practice on the prevention of central-line associated bloodstream infections among nurses in oncological care: A cross-sectional study in an area of southern Italy. PLoS ONE, 12(6). doi: 10.1371/journal.pone.0180473

This study was conducted to determine the attitude and knowledge of nurses concerning safety measures while using central lines and the predisposing factors of CLABs. Nurses in sixteen teaching and non-teaching hospitals in Italy filled questionnaires that sought to delineate their attitudes towards the available standards concerning central lines dressing and insertion and knowledge concerning the available evidence-based practices for CLABs’ control and prevention. Results showed that nurses within the age bracket of 36-50 had limited knowledge concerning CLABs prevention. The same applied to nurses with low academic credentials. Most knowledge was gained from reading academic material. Medical institutions should encompass educational programs to widen nurses’ knowledge base concerning CVC care bundles and improve their attitudes towards the set guidelines for reduced CLABs.

Koll, B. S. & Ruiz, R. E. (2008). The CLABs Collaborative: A Region wide Effort to Improve the Quality of Care in Hospitals. The Joint Commission Journal on Quality and Patient Safety, 34(12), 713-723. doi: 10.1016/S1553-7250(08)34094-X

Thirty six hospitals were guided through three training sessions by “an infectious disease physician consultant” whose main function was to provide clinical guidance and feedback. These hospitals had central line care team whose main objective was to discover new evidence-based treatment mechanisms which prevented CLABs. The team met weekly to practice these treatment mechanisms. The hospital reported decreased CLABs rates of 88% between the intervention and baseline periods. 56% of hospitals with at least one member of the central line team reported a decrease of CLABs rates by at least 50%.

Salama, M. F., Jamal, W., Al Mousa, H. & Rotimi, V. (2015). Implementation of central venous catheter bundle in an intensive care unit in Kuwait: Effect on central line-associated bloodstream infections. Journal of Infection and Public Health, 9(1), 34-41. doi:10.1061/j.jiph.2015.05.001

This study was done to delineate the impact of implementation of CVC care bundles in an ICU in Kuwait. Nurse practitioners were trained by a credentialed infection control team. There was a significant decrease in CLABs cases, it decreased by 24. The study concluded that the implementation of a CVC post-insertion care bundle decreased CLABs obtained from nurse-led CVC insertion and dressing.

Conclusion

Patients with central lines have less chances of obtaining CLABs when care is given by a central line care team responsible for central lines. Results show that most nurses cannot reduce the cases of CLABs even when intervention programs are introduced since their performance while handling central lines depends on their knowledge concerning central line care bundles and their attitude towards the set guidelines. Nurses who have high performance volumes and skills in CVC insertion, dressing and after care services have better chances in reducing CLABs among patients unlike new nurses whose main purpose is primary care.

References

Alexandrou, E. Murgo, M., Calabria, E. … & Hillman, K. M. (2011). Nurse-led central venous catheter insertion-Procedural characteristics and outcomes of three intensive care based catheter placement services. International Journal of Nursing Studies, 1-7.

Esposito,M. R., Guillari, A. & Angelillo, I. F. (2017). Knowledge, attitudes and practice on the prevention of central-line associated bloodstream infections among nurses in oncological care: A cross-sectional study in an area of southern Italy. PLoS ONE, 12(6). doi: 10.1371/journal.pone.0180473

Koll, B. S. & Ruiz, R. E. (2008). The CLABs Collaborative: A Region wide Effort to Improve the Quality of Care in Hospitals. The Joint Commission Journal on Quality and Patient Safety, 34(12), 713-723. doi: 10.1016/S1553-7250(08)34094-X

O’Neil, Caroline., Ball, K. & Warren, D. (2016). A Central Line Care Maintenance Bundle for the Prevention of Catheter-Associated Bloodstream Infection in Non-ICU Settings. Infection Control and Hospital Epidemiology, 37(6): 692-698. doi: 10.1017/ice.2016.32

Perin, D. C., Erdmann, A. L. & Sasso, G. T. (2016). Evidence-based measures to prevent central line-associated bloodstream infections: a systematic review. Rev Lat Am Enfermagem, 24. doi: 10.1590/1518-8345.1233.2787

Salama, M. F., Jamal, W., Al Mousa, H. & Rotimi, V. (2015). Implementation of central venous catheter bundle in an intensive care unit in Kuwait: Effect on central line-associated bloodstream infections. Journal of Infection and Public Health, 9(1), 34-41. doi:10.1061/j.jiph.2015.05.001